Peer Reviewed Articles on Strength Training for Shoulders in Collegiate Overhead Athletes
Int J Sports Phys Ther. 2021; xvi(3): 827–834.
Shoulder Isokinetic Strength Rest Ratio in Overhead Athletes: A Cantankerous-Sectional Study
Valentine Zimermann Vargas
1Departamento de Fisiologia, Universidade Federal de São Paulo (UNIFESP)
Caroline Motta
1Departamento de Fisiologia, Universidade Federal de São Paulo (UNIFESP)
Rodrigo Luiz Vancini
2Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo (UFES)
Claudio Andre Barbosa de Lira
iiiSetor de Fisiologia Humana eastward practice Exercício, Laboratório de Avaliação do Movimento Humano, Faculdade de Educação Física due east Dança, Universidade Federal de Goiás (UFG)
Marilia Santos Andrade
1Departamento de Fisiologia, Universidade Federal de São Paulo (UNIFESP)
Received 2020 Aug 28; Accepted 2020 November 26.
Abstract
Background
Studies have grouped unlike overhead sports and evaluated together the isokinetic strength of shoulder internal (IR) and external (ER) rotator muscles. Withal, muscular adaptations could be a consequence of the specific sport, and some strength imbalance between these muscles may exist as a upshot of the muscular demand unique to the sport. Therefore, group different overhead sports together may non be acceptable.
Purpose
To compare strength balance ratios between different overhead sports (volleyball, handball, swimming, judo, baseball, softball, functional movements performed at loftier-intensity interval training, and tennis) with a command athletic grouping (no overhead grouping).
Study design
Cross-sectional study.
Methods
A total of 237 athletes were submitted to isokinetic shoulder forcefulness tests. The isokinetic concentric and eccentric pinnacle torque values of shoulder internal IR and external ER rotator muscles were measured. Conventional (CR) and functional forcefulness ratios (FR) were calculated.
Results
There were no significant differences between the sports for the CR in the male group. Female softball athletes (90.four±13.half-dozen%) had a significantly higher CR than judo (67.3±6.9%), volleyball (74.9±15.9%), and swimming athletes (70.3±8.7%). In the female person grouping, judo athletes had lower FR values (0.76±0.19) than soccer athletes (1.31±0.35), volleyball athletes (1.24±0.27), functional movements performed at high intensity (1.10±0.1), and softball athletes (ane.40±0.39). Female handball athletes too had a lower FR (0.99±0.25) than soccer athletes (one.31±0.35) and softball athletes (1.twoscore±0.39). Male handball (0.ninety±0.23), tennis (0.86±0.thirty), and judo (0.68±0.22) athletes had lower FR values than soccer athletes (one.20±0.21) and volleyball athletes (1.25±0.28).
Conclusions
CR for males may exist analyzed together, equally in that location were no meaning differences between them. However, for females, the CR for softball athletes should be analyzed individually. As there were several differences between the overhead sports co-ordinate to the FRs, the authors suggest circumspection in grouping overhead athletes beyond multiple sports. These results could take of import implications for the design of injury prevention and rehabilitation programs associated with the shoulder articulation in overhead sports.
Keywords: shoulder rotation, overhead athletes, isokinetic force, balance ratio
INTRODUCTION
The repetitive pattern of muscle use tin cause specific muscular adaptations and bilateral force deficiency, or muscular strength imbalance between antagonistic muscles of the joint, mainly in asymmetric sports.one The muscular isokinetic strength profiles of athletes may aid in understanding these specific muscular adaptations for each sport.2,iii
Muscular strength balance betwixt agonist and antagonist muscles is of fundamental importance for joint stability, ensuring a dynamic centering of the humeral caput,iii mainly while an athlete is playing sports.2 Therefore, the strength balance ratio is of cardinal importance, independently of the athlete's sex. Traditionally, isokinetic force testing has been considered an important tool for monitoring training adaptations and for objectively quantifying the forcefulness balance ratio betwixt agonist and antagonist muscles.iv–6 Regarding the shoulder joint, rotator gage shoulder muscles exhibit an important activeness that ensures dynamic centering of the humeral head to the glenoid.iii Edouard et al.7 showed that the relative injury take a chance of the shoulder joint was ii.57 if athletes had an imbalanced muscular strength contour. For this reason, it is important to accept advisable residual between shoulder internal (IR) and external (ER) rotator muscles.2,8,nine
Many studies have grouped different sports together and, in many cases, have evaluated isokinetic strength and the consequence of exercise programs in a wide category of "overhead athletes".6,ten–12 However, it is unknown whether shoulder muscular residuum ratios are similar between overhead sports. If the balance ratios are different betwixt sports, analyzing the balance ratios together may be erroneous. To the best of the authors' knowledge, there are no data that propose that muscle adaptations due to overhead sports are similar to justify grouping overhead sports. Several studies have evaluated adaptive changes in the shoulder in athletes of several different sports, such every bit judo,13 handball,seven,9,14,15 tennis,ix,ten,16,17 baseball,xviii,19 badminton,xx volleyball,nine,10 and pond,21 but no studies have compared the force balance betwixt overhead sports.
Overhead movements are the main gesture in sports such every bit volleyball, handball, lawn tennis, swimming, and baseball, but there are several distinctions between these sports. They have different movement executions and muscular actions, and they use different implements, such equally unlike types of assurance or rackets.nine Thus, it is of import to know if these differences produce unique adaptations in shoulder strength balance. Noesis about differences between the overhead sports in terms of muscle accommodation could help design tailored prevention and rehabilitation programs for athletes. Thus, the aim of this study was to compare the strength rest ratios betwixt overhead athletes from the different sports. It was hypothesized that strength rest ratios would be different betwixt overhead athletes in different sports, supporting the notion that these athletes should be investigated based on their specific sport rather than categorized as general overhead athletes.
METHODS
Participants
Athletes were recruited from competitive teams (regional level) in São Paulo (Brazil) through straight contact from January to September 2017. To this terminate, the research coordinators visited the teams and invited the coaches and athletes to participate in the written report. Information were nerveless from February to Oct 2017. Volunteers were from eight different sports: volleyball, handball, swimming, judo, baseball (for men) and softball (for women), functional movements performed at loftier-intensity interval training, tennis, and soccer. Soccer athletes served as a control group, since in that location is minimal upper limb interest in this sport (goalkeepers were excluded from the sample).
To be included, athletes had to have trained at to the lowest degree ii hours per day, 5 times per week during at least the last ii years. Exclusion criteria included activity or resting shoulder hurting (greater than iii out of ten on the visual analogic scale),22 upper limb swelling, inability to perform concrete exercises, systemic diseases, surgery in the concluding twelvemonth, orthopedic injuries, interrupted physical training because of shoulder pain in the last six months, and/or other dysfunctions that limit the ability to consummate the testing protocol.
The participants and/or their parents/guardians (for those under 18 years old) were informed virtually the aim of the study and gave their written consent to participate in the protocol. In add-on, athletes under eighteen years former gave their written consent before participation. All experimental procedures were approved by the Research Ethics Commission of the Universidade Federal de São Paulo and conformed to the principles outlined in the Declaration of Helsinki.
Isokinetic forcefulness test
Before each test, the dynamometer was calibrated co-ordinate to the manufacturer'southward specifications. Athletes assumed a seated position, and standard stabilization strapping was placed beyond their breast and hips (Figure 1). The ER and IR rotator muscles from the dominant shoulder were assessed with the athletes' upper limbs abducted at 90 degrees (deg) in the frontal plane and the elbow flexed at xc deg, which is the same position adopted for shoulder muscle isokinetic evaluation in previous studies.23–25 This position has been recommended for evaluations because information technology approximates the throwing position.23,26,27 The range of motion was set to 50 deg of IR rotation and lxx deg of ER rotation to replicate an overhead serving motion27 and to be the same angles used in previous studies.5,24,28,29 Before the isokinetic test, athletes performed a five-minute warm-upwards exercise protocol,30 followed past depression-intensity dynamic stretching exercises for lower limbs, to avoid stretching influence in strength values.31 Post-obit the warm-up period, athletes randomly completed concentric and eccentric isokinetic shoulder strength tests with the dominant limb using an isokinetic dynamometer (System 4 Biodex Medical Systems Inc., Shirley, NY, USA). Before the test, the athletes performed iii trial movements with submaximal performance to familiarize themselves with the equipment, angular speeds, and concentric and eccentric actions.
Effigy 1: Positioning causeless by the participant during isokinetic evaluation of the shoulder.
The concentric test consisted of 5 maximal repetitions of shoulder IR and ER at threescore and 240 deg/sec, respectively.29,32,33 The athwart speed of 60 deg/sec was called equally the lowest athwart speed to avoid high joint pressure while producing the highest torque values.34,35 Additionally, 240 deg/sec was called as the highest speed, once it is close to the functional movements speed without increasing the risk of injury associated to eccentric activity.36 Other studies have also used the same isokinetic test speeds for isokinetic strength evaluation.28,29,32,33 The eccentric test consisted of 5 maximal repetitions at 240 deg/sec. Between sets, participants had 60 seconds of rest time.xiv All athletes were tested by a single evaluator who was trained and experienced in the utilise of isokinetic devices. During the examination, athletes were given the same verbal encouragement. Visual feedback from the computer screen was not permitted. The variables evaluated were the shoulder ER and IR peak torque in concentric activity at 60 and 240 deg/sec, respectively, and ER rotator peak torque in eccentric activeness at 240 deg/sec. With this information, conventional (CR) and functional balance ratios (FR) were calculated. The CR was calculated equally concentric ER peak torque at 60 deg/sec to concentric IR superlative torque at threescore deg/sec (ERconcentric:IRconcentric). The FR was calculated as eccentric ER peak torque at 240 deg/sec to concentric IR summit torque at 240 deg/sec (EReccentric:IRconcentric).
Statistical assay
The normal distribution of each variable was analyzed and confirmed by the Kolmogorov–Smirnov test. The homogeneity of the variance was verified by Levene's examination. All variables were shown every bit the hateful and standard divergence (SD). To compare sports, one-way ANOVA was used. ANOVA was complemented by the Tukey post-hoc test when the threshold of significance was reached. Statistica software (version 12.0, United states) was used to process the analyses. The level of significance was gear up at p < 0.05 and the power level at 0.80.
RESULTS
Two hundred and sixty-four athletes were screened for participation, and of these, 27 were excluded, and then 237 athletes comprised the sample. The 27 athletes excluded from the initial sample were as follows: 3 had upper limb surgery, 11 suffered an orthopedic injury in the final six months, and 13 fell pain during the test. Figure 2 shows the participants' menstruation through the written report.
Figure ii: Study design according to the characteristics of the participants
The characteristics of the athletes are described in Tabular array 1. Ane-way ANOVA revealed a statistically significant deviation between ages of the female groups (F[7,101]=12.32, p<.001, observed ability 1.0) and of the male groups (F[7,120]=15.81, p<.001, observed power i.0). There was too a pregnant departure betwixt body mass of the female person groups (F[7,101]=10.53, p<.001, observed power 1.0) and of the male groups (F[7,120]=7.37, p<.001, observed power .99). Regarding height, there was also a pregnant difference between female groups (F[7,101]=22.99, p<.001, observed power ane.0) and male person groups (F[7,120]=half-dozen.93, p<.001, observed power .99).
Tabular array one: General characteristics of athletes from different sports (overhead and control). Information are presented as the mean ± SD (n).
| Age (years) | Body mass (kg) | Superlative (m) | ||||
|---|---|---|---|---|---|---|
| Sports | F | 1000 | F | M | F | Grand |
| Control (soccer) | 18.two ± 0.4 (n=xvi) | 23.4 ± 5.iv (n=20) | 61.seven ± 5.6 (n=16) | 73.nine ± 8.iv (n=xx) | 1.68 ± 0.05 (n=16) | 1.78 ± 0.06 (north=20) |
| Handball | 28.6 ± 5.0* (north=xx) | 29.0 ± v.2* (n=22) | 71.6 ± 6.0* (n=xx) | 92.2 ± 9.ii* (northward=22) | 1.76 ± 0.05‡ (n=twenty) | ane.87 ± 0.05* (northward=22) |
| Volleyball | 23.vi ± 5.half dozen*,† (north=xix) | xviii.1 ± 0.3*,† (n=17) | 75.six ± 8.1* (n=nineteen) | 78.four ± ix.two† (n=17) | 1.83 ± 0.05* (north=xix) | 1.86 ± 0.08* (north=17) |
| Judo | 27.4 ± 3.iii* (n=15) | 31.eight ± 4.5*,‡ (n=14) | 61.four ± 9.one†,‡ (north=15) | 93.v ± 25.8*,‡ (northward=fourteen) | ane.64 ± 0.07†,‡ (due north=15) | 1.80 ± 0.10 (northward=14) |
| Tennis | 24.0 ± 9.1 (n=half dozen) | 27.half dozen ± half-dozen.iv‡ (n=13) | 64.4 ± 3.6‡ (n=6) | 76.8 ± x.2†,§ (due north=13) | one.64 ± 0.05†,‡ (n=half-dozen) | 1.81 ± 0.08 (n=13) |
| Swimming | 22.5 ± 2.5# (n=6) | 21.0 ± 5.0†,§,** (north=xvi) | 61.2 ± 7.5‡ (due north=6) | 73.one ± 5.five†,§ (n=xvi) | 1.67 ± 0.04‡ (n=half-dozen) | one.78 ± 0.05†,‡ (n=sixteen) |
| FMHI | 29.vii ± 3.three*,‡ (north=17) | 28.7 ± iv.5*,‡,f (n=17) | 61.5 ± 8.3†,‡ (north=17) | 84.9 ± ten.2 (n=17) | i.62 ± 0.07†,‡ (n=17) | i.75 ± 0.06†,‡ (due north=17) |
| Softball | 22.7 ± 2.0†,# (n=10) | - | 58.7 ± 8.0†,‡ (n=10) | - | 1.62 ± 0.08†,‡ (north=10) | - |
| Baseball | - | 28 ± 3.7‡,†† (north=9) | - | 83.5 ± 11.v (n=9) | - | ane.74 ± 0.07†,‡ (n=9) |
F: female, M: male, FMHI: functional movements performed at loftier intensity. The differences observed were related to the aforementioned sexual activity. * p < 0.05 – dissimilar from control grouping; † p < 0.05 – different from handball group; ‡ p < 0.05 – different from volleyball group; § p < 0.05 – unlike from judo group; ** p < 0.05 – unlike from tennis grouping; †† p < 0.05 – different from swimming grouping; # p < 0.05 – different from FMHI grouping.
The values of CR and FR of male and female person athletes from different sports are shown in Tabular array 2. One-way ANOVA revealed a statistically meaning event of sport on CR in the female group (F[7,101]=3.55, p=.002, observed ability .96) and in the male group (F[7,120]=2.29, p=.031, observed ability .82). There was also a significant effect of sport on FR in the female group (F[7,101]=7.10, p<.001, observed ability .99) and in the male person group (F[i,120]=9.65, p<.001, observed power .99).
Table two: Conventional (CR) and functional (FR) balance ratios of the athletes from different sports, grouped past sex. Information are presented every bit means ± SD.
| Sports | Female person | Male |
|---|---|---|
| Soccer | ||
| CR (%) | lxxx.4 ± 12.0 | 78.4 ± 22.3 |
| FR | 1.31 ± 0.35 | 1.20 ± 0.21 |
| Handball | ||
| CR (%) | 76.half dozen ± 12.2 | 67.4 ± 28.5 |
| FR | 0.99 ± 0.25)*,‡ | 0.90 ± 0.23*,† |
| Volleyball | ||
| CR (%) | 74.9 ± 15.9‡ | lxxx.nine ± 14.2 |
| FR | 1.24 ± 0.27 | 1.25 ± 0.28 |
| Judo | ||
| CR (%) | 67.3 ± 6.9‡ | 66.7 ± ten.8 |
| FR | 0.76 ± 0.19*,†,‡,§ | 0.68 ± 0.22*,†,‡,§,** |
| Lawn tennis | ||
| CR (%) | 72.2 ± xiii.3 | 66.6 ± 10.9 |
| FR | 1.eleven ± 0.33 | 0.86 ± 0.xxx*,†,** |
| Swimming | ||
| CR (%) | 70.iii ± 8.7‡ | seventy.5 ± 10.nine |
| FR | 1.13 ± 0.27 | 1.15 ± 0.23 |
| FMHI | ||
| CR (%) | 76.4 ± 12.0 | 63.five ± 8.8 |
| FR | 1.ten ± 0.1 | 1.00 ± 0.22 |
| Baseball/Softball | ||
| CR (%) | 90.4 ± 13.6 | 79.0 ± sixteen.two |
| FR | 1.40 ± 0.39 | 1.05 ± 0.24 |
FMHI= functional movements performed at high intensity. The differences observed were related to the same sex. *p<0.05 different from control; †p<0.05 different from volleyball; ‡p<0.05 different from softball/baseball game; §p<0.05 different from FMHI; and **p<0.05 unlike from swimming.
The significant p-values for the differences between sports are shown in Table 3. Male athletes had no CR differences betwixt sports. Moreover, the overhead athlete groups were not dissimilar from the control group. Conversely, female athletes had significantly higher CR values in the softball grouping than in the judo (p <.01), volleyball (p=.04), and pond groups (p=.04) (Tables ii and iii).
Tabular array iii: Meaning p values for pairwise comparisons
| Soccer (controls) | Handball | Volleyball | Judo | Tennis | Pond | FMHI | Softball/ Baseball | |
| Soccer (controls) | X | F = 0.02* M <0.01* | F <0.01* M <0.01* | One thousand <0.01* | ||||
| Handball | X | |||||||
| Volleyball | Grand <0.01* | X | F <0.01* Thousand <0.01* | M <0.01* | ||||
| Judo | X | |||||||
| Lawn tennis | X | |||||||
| Swimming | M <0.01* | M = 0.04 | X | |||||
| FMHI | F <0.01* Chiliad <0.01* | 10 | ||||||
| Softball/ Baseball | F <.001* | F = 0.04† | F <0.01† F <0.01* Grand=0 .01 | F =0.04† | Ten |
*P values for FR; † p values for CR; F = female person; G = male.
For the FR in the male athlete groups, the judo athletes had lower FR than the controls (p<.01), volleyball athletes (p<.01), swimmers (p<.01), functional movements performed at high-intensity interval training athletes (p<.01), and baseball game athletes (p=.01). Tennis and handball athletes besides had lower FR values than controls and volleyball athletes (p<.01). Moreover, lawn tennis athletes as well had lower FR than swimmers (p=.04) (run into Tables 2 and 3). The female person judo athletes had lower FR compared to the control group (p<.01), volleyball (p<.01), functional movements performed at high-intensity interval training (p<.01), and softball (p<.01) athletes. Female handball athletes showed lower FR values than the control group (p=.02) and softball athletes (p<.01).
DISCUSSION
The aim of the current study was to compare the CR and FR betwixt overhead sports (volleyball, handball, pond, judo, tennis, functional movements performed at high-intensity interval training, and baseball/softball) with a control group composed of soccer athletes. The main findings were that the CR was non significantly dissimilar betwixt all male overhead sports and between the overhead sports and the control group. Only female softball athletes had a higher CR than female judo, volleyball, and swimming athletes. Conversely, the FR was significantly different betwixt the sports evaluated. In the female group, the judo and handball athletes had lower FR values, and for male person athletes, judo, handball, and tennis athletes had lower FR values.
Softball athletes had the highest CR. High values for this variable indicate weakness of the shoulder IR rotator muscles relative to the strength of the ER rotator muscles. The specificity of the throwing motility of this sport may contribute to this finding. Indeed, a softball throw is substantially unlike from other sports. At the moment a softball is thrown, the shoulder joint has less than 90 deg of flexion. Consequently, the shoulder'south IR activity is not as articulate as with other sports that involve an overhead throw, using more than than 90 deg of shoulder flexion.37 Ellenbecker and Davies8 suggested that the CR should be between 66% and 75% in society to plant good joint stability and to avoid shoulder injuries. Therefore, too the softball athletes presenting higher CR values (xc.iv ± 13.6%) than the judo (67.3 ± six.9%), volleyball (74.9 ± xv.ix%), and swimming athletes (70.3 ± eight.7%), the softball grouping also had values that were higher than the recommended values in the literature. To the best of the authors' knowledge, in that location are no previous studies about isokinetic shoulder strength balance in softball athletes. Therefore, these are the first data showing shoulder forcefulness imbalance in these athletes. Given that there were no significant differences in the CR between the female control, handball, volleyball, judo, lawn tennis, swimming, and functional movements performed at loftier-intensity interval training groups, it is reasonable to suggest that these sports could be analyzed together in futurity studies. CR for all the male groups evaluated in this written report were all like; therefore, it is as well reasonable that the CR data for men from the overhead sports in this study can exist grouped and analyzed together.
Male athletes from the functional movements performed at high-intensity interval grooming modality—besides presenting CRs that were not significantly unlike from the other sports —had a mean CR value lower (63.5 ± 8.8%) than the literature recommendation (66–75%),eight which is besides lower than previous literature information for this sport.29 Athletes from the functional movements performed at loftier-intensity interval grooming modality characteristically applied a powerful sportive gesture, especially related to the shoulder IR muscle. In functional movements performed at high-intensity interval preparation, there are no throwing actions, which could limit the development of the shoulder ER muscles. This state of affairs corroborates the presence of a low CR.xiii Hadzic et al.38 evaluated volleyball athletes' IR and ER muscles in the same angular speed and test position. The authors found CR of 61% and 74% for male and female person athletes, respectively. Female volleyball athletes from the current study had very similar results (75%), but male volleyball athletes had a higher CR (81%). Comparing handball athletes from the current study with previously published information from the same test athwart speed and position, like values were observed for the CR. Andrade et al.14 institute a CR of 79% for female handball athletes, and Andrade et al.15 found the CR to be 72% for male handball athletes, while the current study found it to exist 76% for female person and 67% for male handball athletes.
For the female person grouping, judo athletes had the lowest FR values, which were significantly lower than the values in the control, volleyball, functional movements performed at high-intensity interval training, and softball groups. The second lowest FR values were in handball athletes, which were lower than in the command and handball groups. The FR is characterized by the ER summit torque in eccentric action divided by the IR peak torque in concentric activity; therefore, lower values indicate a low eccentric forcefulness of ER muscles. Noffal36 hypothesized that eccentric ER torque should be greater than concentric IR torque to be able to overcome and to decelerate the shoulder movement generated by the concentric action of IR muscles. The results in female judo and handball athletes were not only lower than those of the other studied groups, but their mean values were as well lower than those reported for shoulder stability (FR > 1.0).36 Regarding female handball athletes, the information reported in the literature14 were higher than those observed in the current study. These authors found a FR of 1.21 ± 0.28 for the dominant upper limb; however, these authors evaluated the isokinetic forcefulness at 300 deg/sec, and the higher speed used in their written report could be responsible for the higher FR values. Along these lines, Edouard et al.vii found lower FR values (0.75 ± 0.fifteen) for a population with the same characteristics; however, they assessed the isokinetic strength at 60 deg/sec. In the present study, a higher angular speed test (240 deg/sec) was chosen considering it was closer to the functional throwing activity than the lower speed (60 deg/sec) selected past Edouard et al.7 Conversely, an athwart test speed higher than 240 deg/sec was not employed considering it is difficult for athletes to perform eccentric activeness at athwart speeds that are too loftier (commonly they cannot reach very high eccentric speeds). Therefore, it is difficult to compare study results considering the angular speeds tested were dissimilar.
Like to the female grouping, the male judo and handball athletes, in addition to the tennis athletes, besides had depression FR values. The judo athletes had lower FR than the control, volleyball, swimming, baseball, and functional movements performed at high-intensity interval training athletes. Besides, handball and tennis athletes had lower FR values than the command and volleyball groups, and tennis athletes also had lower FR than swimmers. Andrade et al.5 evaluated handball athletes and assessed muscular isokinetic strength at 90 (concentric mode) and 300 deg/sec (eccentric mode) and likewise plant hateful FR values lower than i.0. Additionally, Saccol et al.sixteen observed FR lower than 1.0 for tennis athletes.
Strength evaluations at different isokinetic angular speeds were not performed, which could exist considered a report limitation; it could exist helpful to compare the results with previously published data. Therefore, future studies should exist performed at dissimilar speeds. Another recommendation for time to come studies is to include other sports commonly grouped in overhead nomenclature, such every bit badminton, water polo, or lacrosse.
Conclusions
CR for male person overhead athletes may be analyzed together because in that location were no significant differences betwixt them. Notwithstanding, for females, CR for softball athletes should be analyzed individually because they had higher values. Every bit the FR for the male group had several differences across overhead sports, group all the evaluated sports, in order to evaluate these variables, should be done carefully. The sports that can be grouped together based on the FR assay are volleyball, swimming, functional movements performed at loftier-intensity interval grooming, and baseball game, or in a dissimilar group handball, judo, and tennis. For analyzing FR in a female group, overhead athletes (volleyball, swimming, softball, functional movements performed at loftier-intensity interval grooming, tennis) may be grouped and analyzed together, every bit there were no differences betwixt them; only female person judo and handball athletes should be excluded from the group. In full general, these results could have of import implications for the design of training programs and injury prevention, besides as rehabilitation programs associated with the shoulder joint and "overhead athletes."
Conflicts of Interest
The authors declare no conflicts of interest.
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Articles from International Journal of Sports Physical Therapy are provided here courtesy of North American Sports Medicine Institute
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169013/
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